Form VTR-61 Rev 04/15 Page 1 of 2Online form at www.TxDMV.gov

Rebuilt Vehicle Statement

Vehicle/Owner InformationVehicle Vehicle Identification Number Year Make Body Style Model

Owner Owner's printed legal name

Address Owner's mailing address (street address, city, state, and zip)

Details of Work PerformedRebuilder Rebuilder's printed legal name

Address Rebuilder's address (street address, city, state, and zip)

Work Performed

The individual (rebuilder) who repaired, rebuilt, reconstructed, or assembled the vehicle must provide an explanation as to the work done to repair, rebuild, reconstruct, or assemble the motor vehicle and specify the location* of any component parts replaced:

* Right (R), Left (L), Front (F), Rear (R), Right Front (RF), Left Front (LF), Right Rear (RR), Left Rear (LR)NOTE: Page 2 must be completed if component parts were used to repair, rebuild, reconstruct, or assemble.

Rebuilder Statement

Signature of Rebuilder Date

I, the rebuilder (as listed above), certify I repaired, rebuilt, reconstructed, or assembled the vehicle described above and purchased or came into possession of all the component parts listed on Page 2 in a legal and lawful manner in accordance with the provisions of Transportation Code, Chapter 501.

Inspection Information

General Information

Inspection

An authorized Texas Department of Public Safety state vehicle inspection station must inspect the vehicle after it has been repaired, rebuilt, reconstructed, or assembled. Upon completion, the inspection station will provide a Vehicle Inspection Report (VIR). A copy of the VIR may be required if the inspection cannot be automatically verified at the time of application for Texas title and registration. NOTE: An additional inspection, completed on the Form VTR-64 (or Form VTR-852, if applicable), is also required for any newly assembled vehicle that has not previously been titled as a complete vehicle.Authorization number or code (located on the VIR) Date of inspection (located on the VIR)

Owner StatementI, the owner (as listed above), certify I am the legal and rightful owner of the vehicle described above; the vehicle has been repaired, rebuilt, reconstructed, or assembled; the vehicle has been inspected, and the vehicle identification number (VIN) provided above is the same as the VIN affixed to the motor vehicle.

DateSignature of Owner

State law makes falsifying information on any document required by the department a third degree felony.

NOTE: The owner and rebuilder may be the same; therefore, the same individual may sign both statements.

Form VTR-61 Rev 04/15 Page 2 of 2Online form at www.TxDMV.gov

Rebuilt Vehicle StatementThese sections must be completed by the rebuilder if the vehicle has been repaired, rebuilt, reconstructed, or assembled with any of the listed

component parts.

Component Parts - Engine, Frame, and Body

Engine

Frame

Body

Component Part Component Part Number (Required)

Origin of Component Part/Purchased from: (Name and complete address)

Component Parts - Other

Transmission

Fender(s)*

Hood

Component Part Component Part Number (If available)

Origin of Component Part/Purchased from: (Name and complete address)

Tailgate/Deck Lid/Hatchback

Pickup Cargo Box (vehicle 10,000 pounds or less)

Cab of a Truck

Door(s)*

Bumper(s)*

Quarter Panel(s)*

Roof or Floor Pan (passenger vehicle, if separate from body)

* Specify the location of the component part on Page 1 in the “Details of Work Performed” section.

NOTE: Ownership evidence (bill of sale and/or title) is required if an engine, frame, or body is used.

NOTE: Submit any bills of sale for these component parts (if any).